Diuretic Therapy In Patients Research Articles

Changes in blood pressure and body fluid volumes during diuretic therapy in patients with essential hypertension who receive enalapril.

We evaluated the effect of additional chlorthalidone therapy on blood pressure and body fluid volumes in 10 patients with essential hypertension who did not respond to chronic converting enzyme inhibition with enalapril. Values assessed after 3 days and 6 weeks of combined enalapril and chlorthalidone therapy were compared with initial values during enalapril monotherapy. After 3 days the mean arterial pressure (MAP), plasma volume (PV), blood volume (BV), and extracellular fluid volume (ECFV) decreased. There was a positive correlation between the percentage decreases in MAP and BV. After 6 weeks the MAP decreased further, but the decreases in PV, BV, and ECFV were less pronounced. At this time there was a positive correlation between the percentage decreases in MAP and ECFV. Our results support the hypothesis that contraction of the ECFV is an antihypertensive mechanism of diuretics. The antihypertensive effect of diuretics is enhanced during converting enzyme inhibition, while the body remains protected against volume deficits, possibly by the lower blood pressure itself.

Carbenoxolone: a review of its pharmacological properties and therapeutic efficacy in peptic ulcer disease.

Carbenoxolone sodium has been shown to accelerate the rate of healing of both gastric and duodenal ulcers, but its overall value in duodenal ulcer is probably less because of the high rate of natural remission of duodenal ulcers. Further studies are required to decide whether it should be used prophylactically to delay ulcer recurrence. Carbenoxolone may act by affecting both the proliferative activity of gastric epithelium and the differentiation of the epithelial cells to produce mucus (as well as favourably altering the physicochemical properties of mucus and by reducing peptic activity), factors which may be relevant ot the prevention of acute gastric ulcers. Some studies suggest that carbenoxolone adds to the effect of hospitalisation and bed rest on ulcer healing. Whether bed rest confers additional benefit to the drug's ulcer healing effect in outpatients is also uncertain. There is no evidence that accelerated healing by carbenoxolone is associated with improved overall prognosis. Carbenoxolone is of greatest benefit in accelerating the healing of gastric ulcers in patients for whom hospitalisation is not possible or desirable, but it should only be used in the ambulatory patient when careful and regular observation of serum electrolytes (particularly potassium), blood pressure and weight is possible and when it is known that the patient will attend regular follow-up. Patient must be educated in the proper use of the drug. If severe mineralocorticoid-like toxic effects such as sodium and water retention and hypokalaemia appear, as they do in a variable proportion of patients but most frequently in those receiving excessive doses, carbenoxolone should be stopped and the complication treated; they respond to thiazide diuretics and potassium supplements, and probably to amiloride given in conjunction with a low dose of a thiazide diuretic. Treatment with carbenoxolone can continue with concurrent diuretic therapy in patients with less severe side-effects. Optimum therapeutic effect in gastric ulcer with the least side-effects is achieved with a dosage of 100mg carbenoxolone tablets 3 times daily for the first week followed by 50mg 3 times daily thereafter, best taken before meals. A lower dosage is desirable in the elderly and in those with liver, cardiac or renal disease. Barium meal or preferably endoscopic examinations should be performed regularly and therapy continued until the ulcer is healed. Dosage for duodenal ulcer is 50mg 4 times daily, in special positioned-release capsules. These are best taken about 20 minutes before meals.

Clinical effects and complications of diuretic therapy in patients with cirrhosis

1) Fluid retention disappear in some cases in early stage of liver cirrhosis without diuretic therapy. 2) Diuretices have little effect and may accelerate the heavy electrolyte disturbance in already seriously ill patients. 3) Sever ill patients with cirrhosis and intractable ascites should not be treated too vigorously.

THE COMPLICATIONS OF DIURETIC THERAPY IN PATIENTS WITH CIRRHOSIS

Annals of the New York Academy of SciencesVolume 139, Issue 2 p. 497-505 THE COMPLICATIONS OF DIURETIC THERAPY IN PATIENTS WITH CIRRHOSIS S. Sherlock, S. Sherlock Royal Free Hospital, London, EnglandSearch for more papers by this authorJ. G. Walker, J. G. Walker Royal Free Hospital, London, EnglandSearch for more papers by this authorB. Senewiratne, B. Senewiratne Royal Free Hospital, London, EnglandSearch for more papers by this authorA. Scott, A. Scott Royal Free Hospital, London, EnglandSearch for more papers by this author S. Sherlock, S. Sherlock Royal Free Hospital, London, EnglandSearch for more papers by this authorJ. G. Walker, J. G. Walker Royal Free Hospital, London, EnglandSearch for more papers by this authorB. Senewiratne, B. Senewiratne Royal Free Hospital, London, EnglandSearch for more papers by this authorA. Scott, A. Scott Royal Free Hospital, London, EnglandSearch for more papers by this author First published: November 1966 https://doi.org/10.1111/j.1749-6632.1966.tb41223.xCitations: 13AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume139, Issue2The Physiology of Drug AgentsNovember 1966Pages 497-505 RelatedInformation